Family Name (Capital Letters): 

Given Name: 

Middle Name : 

Street Number & Name:

City:

State or Province:

Zip Code:

Telephone:

Fax:

Date of Birth(mm/dd/yy):

Province of birth:

 U.S Social Security (if any): 

Highest Level of Education:

 Major Field of Study:

Your Foreign Address:

Do you have valid passport:

Are you filing any other petitions with this one?:

Are applications for replacement/initial I-94's being filed with this petition?:

Are applications by dependents being filed with this petition?: 

Is any person in this petition in exclusion or deportation proceedings?: 

Have you ever filed an immigrant petition for any person in this petition?: 

Within the past 7 years, has any person in this petition ever been given the   classification you are now requesting?:

Within the past 7 years, has any person in this petition ever been denied the   classification you are now requesting?: 

If the foreign national is or was in H-1, H-4, L-1 or L-2 Visa status, please list the   dates in that status (from mm/yy to mm/yy):

If the Foreign National / Beneficiary is in the U.S., please complete the following:

Most Recent Date of Arrival (month/day/year):

I-94 #:

Current Nonimmigrant Status (F-1, B-2, H-1B, etc.): 

Expires on (month/day/year):

If currently on H-1B, Receipt # (starts with EAC, LIN, SRC or WAC):

If yes, what date does your OPT / CPT Expire (mm/dd/yyyy):

Passport #:

Date Passport Issued:

Date Passport Expires

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